Provider Demographics
NPI:1558732313
Name:BLINOFF-MUDD, RACHELLE (ATC)
Entity Type:Individual
Prefix:
First Name:RACHELLE
Middle Name:
Last Name:BLINOFF-MUDD
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5125 BRIGGS AVE
Mailing Address - Street 2:
Mailing Address - City:LA CRESCENTA
Mailing Address - State:CA
Mailing Address - Zip Code:91214-3002
Mailing Address - Country:US
Mailing Address - Phone:657-217-0580
Mailing Address - Fax:
Practice Address - Street 1:2000 OTTERBEIN AVE
Practice Address - Street 2:
Practice Address - City:ROWLAND HEIGHTS
Practice Address - State:CA
Practice Address - Zip Code:91748-3949
Practice Address - Country:US
Practice Address - Phone:657-217-0580
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-10-19
Last Update Date:2015-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer